The mental health care Asian American and Pacific Islanders need
May 8, 2018

Hideko Sera, associate dean of U of R’s School of Education, shares her thoughts on the occasion of Mental Health Awareness Month and Asian American and Pacific Islander Heritage Month. (Photo by Coco McKown '04, '10)
by
Hideko Sera

When you find a psychologist, therapist, or counselor from a website or a referral source and show up for your first appointment, what is the chance of being greeted by someone who looks like you, speaks your language, understands your dialect, and appreciates your cultural and traditional beliefs and practices? If you are an Asian American or Pacific Islander, the odds are not good.

Most mental health professionals, however, must at least aim to be culturally competent by keeping some basic information in mind. And Asian Americans or Pacific Islanders need to scrutinize how culturally competent their mental health providers are.

One of the most prominent myths about Asian Americans and Pacific Islanders is the group is homogeneous. In fact, it contains over 50 different ethnic groups and more than 800 different spoken languages and dialects. Socioeconomic statuses and characteristics, religious practices, food choices and preferences, traditional practices, and immigration practices and histories differ greatly. The diversity within this particular group is far richer than most Americans recognize.

This diversity extends to the area of mental health, including help-seeking behaviors, beliefs about seeking help, access to quality care, and typical clinician-client goodness of fit. The range of “mental health issues” is also vast—encompassing relationship difficulties, learning disabilities, cognitive and thought difficulties, various forms of trauma, identity formation, loss and grief, substance use and abuse, depression and anxiety, mood disorders, difficult personalities, eating disorders, sleep hygiene issues, and thoughts related to harming self and others—presenting another challenge in identifying how best to provide an appropriate care.

One of the most prominent struggles for many Asian Americans and Pacific Islanders contemplating seeking out mental health guidance and treatment is the strong notion of shame. Numerous research findings show that Asian Americans and Pacific Islanders underutilize traditional mental health services due to a fear of not only causing individual shame but also casting shame on one’s family and community. Stigma management related to mental health services continues to be a collective struggle for many Asian Americans and Pacific Islanders.

For this reason, distress is often understood and expressed in more culturally acceptable ways, and Asian Americans and Pacific Islanders experience more psychosomatic issues than their White counterparts, as they receive more acceptance when complaining about physiological symptoms than psychological ones. In fact, in some Asian American and Pacific Islander subcultures, there are no equivalent words for “depression” and “anxiety.” Perhaps it is not surprising that research also indicates that Asian Americans and Pacific Islanders are more likely to terminate treatment prematurely when compared to other ethnoracial groups.

It is also true that traditional Western or European psychological and therapeutic approaches depend on verbally explicit communication styles. Asian Americans and Pacific Islanders tend to use what is called a high context communication style instead, which means that nonverbal behaviors are considered more telling about the person’s true intentions than explicitly spoken words. If an Asian American or a Pacific Islander individual is provided with traditional psychological and therapeutic “talk therapy” without any culturally appropriate approaches, there is a risk of not only cultural irrelevance but also a violation of cultural norms.

According to prominent Asian American psychologist Gayle Iwasawa, there are a few implications for culturally competent mental health care specifically with Asian Americans and Pacific Islanders.

Treatment providers should be aware of inaccurate historical stereotypes and myths about Asian Americans/Pacific Islanders and how they have affected the mental health of Asian Americans/Pacific Islanders.

Treatment providers should assess their own stereotypes and myths about Asian Americans/Pacific Islanders and work to abolish them.

Treatment providers should be knowledgeable of the diversity in educational and occupational achievement among Asian Americans/Pacific Islanders.

Treatment providers should be knowledgeable about the socioeconomic status of Asian Americans/Pacific Islanders and the frequent need for family members to have multiple employment in order to make ends meet.

Treatment providers should be aware of the environmental context in which their Asian- American/Pacific Islander clients live and be cognizant of the implications of their suggested treatment on the clients' family members, as it will likely influence treatment adherence.

Treatment providers should understand that Asian Americans and Pacific Islanders are immensely diverse in many ways and not make assumptions about a client's experiences and adherence to traditional cultural values and practices.

Mental health issues for Asian Americans and Pacific Islanders become further complicated when other prominent matters such as expectations related to gender roles, stereotyped notions of masculinity and femininity, filial piety and other family-based responsibilities, and academic and financial successes intersect with educational and health disparities.

I can assure you that although we may share a common place where we have appreciation and respect for our rich traditions and histories, we are not all the same. And being denied our individuality and unique differences is a psychological and emotional burden that does not belong in the field of mental health, nor in our everyday interactions. Psychologists Derald Wing Sue and David Sue have named such denial as a form of microaggression—specifically, microinvalidation. Culturally competent mental health care is not only based on understanding all forms of psychological and emotional struggles, but also on comprehensively and critically understanding individual and systemic experiences of stereotypes, racism, and sexism faced by those who seek healing and provide relevant care.